Nobuyuki Nosaka

Characteristics and costs of ditch-related injuries: a report from a single emergency center in Okayama

This study was designed to identify the incidence, injury patterns, and financial burden of ditch‐related injuries to provide a reference for establishing guidelines on the prevention of such injuries.

Anti-high mobility group box-1 monoclonal antibody treatment of brain edema induced by influenza infection and lipopolysaccharide

Encephalopathy is a major cause of influenza‐associated child death and severe neurological sequelae in Japan, highlighting the urgent need for new therapeutic strategies. In this study, we evaluated the effects of anti‐high mobility group box‐1 monoclonal antibody (α‐HMGB1) treatment on brain edema induced by influenza A virus (IAV) and lipopolysaccharide in 4‐week‐old BALB/c female mice. The results showed that administration of 7.5 mg/kg α‐HMGB1 1 h after IAV (A/Puerto Rico/8/34) inoculation significantly alleviated brain edema at 48 h after IAV inoculation, as confirmed by the suppression of Evans Blue dye leakage and matrix metallopeptidase‐9 mRNA expression in the brain. Moreover, we also observed suppression of oxidative stress and different cytokines in IAV‐inoculated mice. The expression of plasminogen activator inhibitor‐1 was also attenuated following treatment with α‐HMGB1. Notably, α‐HMGB1 treatment had no effect on virus propagation in the lung. In summary, anti‐HMGB1 treatment may improve the prognosis in cases with influenza‐associated encephalopathy by attenuating brain edema and reducing the inflammatory responses induced by HMGB1.

Recurrent apnea in an infant with pertussis due to household transmission

Bordetella pertussis causes life‐threatening apnea in infants. Lymphocytosis is an important clue for diagnosis and for determining the severity of pertussis. Antibiotics do not shorten or ameliorate the disease and only decrease the risk of transmission. Antepartum maternal immunization is important for preventing pertussis in infants.

Development of a Japanese scale for assessment of paediatric normal weight.

The Broselow tape (BT) system has helped health care profesionals succeed in avoiding errors made in paediatric acute care.1 lthough the BT has been used worldwide, it is not surprising that his American-based scale has limited applicability to paediatric opulations outside of the United States.2,3 We therefore aimed o develop a length-based weight estimation scale for Japanese hildren, the Japanese Paediatric Assessment of Normal weight JAPAN) scale. We used data of participants in a large, ongoing ongitudinal survey conducted in Japan (the Longitudinal Survey f Babies in the 21st Century4), to achieve better performance of he JAPAN scale. We also described our method of developing the cale. We obtained 370,980 measurements of body weight and height rom 39,547 participants 12–155 months old. We created the APAN scale using 75% of measurements, randomly selected from he total using the Stata random-number function binomial. We alculated and listed means of weight (kg) and the number of amples according to height, ranging from 45 cm to 179 cm, in n integral format. We then linked weight with height, begining with a height of 72 cm, with more than 100 measurements. p to 19 kg, we rounded means of weight to whole numbers and hecked the corresponding heights. For weights between 19 kg nd 36 kg, we considered the means of weights 19.5–20.9 kg to e 20 kg, those of 21.0–22.9 kg to be 22 kg, and so on up to 6 kg, and checked the corresponding heights. To check validity f the scale compared with the BT (2007 and 2011 versions), we pplied the three scales to the remaining 25% of measurements nd calculated mean absolute error as well as root mean square rror (RMSE) for each scale.5 Stata Statistical Software Release 13 StataCorp LP, College Station, TX, USA) was used for all analyes. The relationship between weight and ranges of height for the APAN scale is shown in Table 1. The newly developed JAPAN scale erformed better than the 2007 and 2011 versions of the BT. For the APAN scale vs. the BT 2007 vs. the BT 2011, mean absolute error kg) was 1.79 vs. 1.85 vs. 1.91, and RMSE (kg) was 2.77 vs. 2.92 vs. .80, respectively. Considering that the JAPAN scale was developed based on a apanese paediatric population and performed best for Japanese hildren, each country should develop a similar weight estimation cale for its own paediatric population, using available anthroometric data. Because of changing paediatric growth patterns ithin each country, these weight estimation methods should be pdated or re-evaluated regularly. Use of an appropriate scale in an 4

Soft tissue hematoma of the neck due to thyroid rupture with unusual mechanism.

Highlights • Massive bleeding from the thyroid without direct neck trauma rarely causes airway compromise.• Physicians should regard possible thyroid gland rupture in patients with swelling of the neck or acute respiratory failure after direct/indirect trauma to the neck.• Airway management is the most important consideration in such patients with thyroid injury.

Targeted age, device deployment, and problems associated with pediatric defibrillation in pediatric prehospital emergency medical care settings in Japan

The use of automated external defibrillators was expanded to include infants according to the 2010 cardiopulmonary resuscitation guidelines in Japan. However, deployment has been slower for pediatric patients in Japan, because there are fewer appropriate pediatric patients for automated external defibrillators than adults. This study aimed to investigate the targeted age range for pediatric defibrillation and device deployment of defibrillators for pediatric patients in prehospital emergency medical care settings in Japan, and present the issues associated with automated external defibrillators.

Acute respiratory distress syndrome in a child with severe epileptic disorder treated successfully by extracorporeal membrane oxygenation: a case report

BackgroundExtracorporeal membrane oxygenation (ECMO) is now a candidate therapy for children with acute respiratory failure.Case presentationWe report our experience of using central ECMO therapy for acute respiratory distress syndrome followed by seizure in a 15-month-old girl with a severe epileptic disorder. Her respiratory distress was refractory to standard medical treatment and mechanical ventilatory support. Her condition was complicated by development of a pneumothorax. The patient was successfully weaned off ECMO and discharged without deterioration of her neurological status.ConclusionThe successful outcome in this case resulted from the central ECMO, which enabled “lung rest” and adequate cerebral blood flow. In skilled ECMO facilities, early implementation of ECMO would give some advantages to patients such as the one presented here. Given the invasiveness and the ease of the procedure, introduction of dual-lumen catheters adequately sized for pediatric patients in Japan is required.

Medical equipment deployment in pediatric emergency prehospital medical units in Japan

The deployment status of pediatric emergency equipment in ambulances in Japan is unknown. To investigate the status of and issues associated with prehospital emergency medical care for pediatric patients, we conducted a descriptive epidemiological study. We carried out a Web‐based survey of 767 fire defense headquarters in Japan, of which 671 responded (valid response rate, 88%). Most of the fire defense headquarters equipped all of their ambulances with oxygen masks (82%), bag‐valve masks (for neonates, 83%; for children, 84%), straight laryngoscope blades (for neonates, 47%; for children 68%), blood pressure cuffs for children (91%), oximeter probes (78%), and stiff neck collars (91%); but despite the need for other equipment such as nasopharyngeal and oropharyngeal airways, and Magill forceps, they were insufficiently deployed. In Japan, prehospital emergency medical equipment deployment does not meet the needs of pediatric patients. Minimum equipment standards need to be established for pediatric prehospital care.

Combined effect of anti-high-mobility group box-1 monoclonal antibody and peramivir against influenza A virus-induced pneumonia in mice: HATAYAMA et al.

Human pandemic H1N1 2009 influenza virus causes significant morbidity and mortality with severe acute lung injury due to the excessive inflammatory reaction, even with neuraminidase inhibitor use. The anti‐inflammatory effect of anti‐high‐mobility group box‐1 (HMGB1) monoclonal antibody (mAb) against influenza pneumonia has been reported. In this study, we evaluated the combined effect of anti‐HMGB1 mAb and peramivir against pneumonia induced by influenza A (H1N1) virus in mice. Nine‐week‐old male C57BL/6 mice were inoculated with H1N1 and treated with intramuscularly administered peramivir at 2 and 3 days post‐infection (dpi). The anti‐HMGB1 mAb or a control mAb was administered at 2, 3, and 4 dpi. Survival rates were assessed, and lung lavage and pathological analyses were conducted at 5 and 7 dpi. The combination of peramivir with the anti‐HMGB1 mAb significantly improved survival rate whereas the anti‐HMGB1 mAb alone did not affect virus proliferation in the lungs. This combination therapy also significantly ameliorated histopathological changes, neutrophil infiltration, and macrophage aggregation by inhibiting HMGB1, inflammatory cytokines, and oxidative stress. Fluorescence immunostaining showed that the anti‐HMGB1 mAb inhibited HMGB1 translocation from type I alveolar epithelial cells. In summary, combining anti‐HMGB1 with conventional anti‐influenza therapy might be useful against severe influenza virus infection.

Serum Procalcitonin Levels in Acute Encephalopathy with Biphasic Seizures and Late Reduced Diffusion

Procalcitonin (PCT) is used as a biomarker in severe infections. Here, we retrospectively investigated levels of serum PCT, C-reactive protein (CRP), and inflammatory cytokines (IL-6, TNF-α, and IFN-γ) in the second phase of patients with acute encephalopathy with biphasic seizures and late reduced diffusion (AESD). Nine AESD pediatric patients (4 men, 5 women; AESD group) admitted to Okayama University Hospital from 2010 to 2016 were compared with 10 control patients with febrile seizures (FS) (3 men, 7 women; FS group). Mean PCT concentrations (ng/mL) in the AESD and FS groups were significantly different, at 9.8 ± 6.7 and 0.8 ± 0.9, respectively (p = 0.0006). CRP (mg/dL) were 0.79 ± 0.89 and 1.4 ± 1.0 (p = 0.94), respectively; IL-6 (pg/mL) were 449.7 ± 705.0 and 118.3 ± 145.4 (p = 0.20), respectively; TNF-α (pg/mL) were 18.6 ± 12.5 and 16.6 ± 6.0 (p = 0.67), respectively; and IFN-γ (pg/mL) were 79.6 ± 158.5 and 41.9 ± 63.7 (p = 0.56), respectively. Ratios of PCT to CRP were 27.5 ± 34.2 and 3.2 ± 6.8 (p < 0.0001), respectively. The sensitivity and specificity in the diagnosis of AESD using a cutoff of PCT/CRP ratio of 1.0 were 79% and 100%, respectively. These results suggest that PCT and the PCT/CRP ratio are useful in auxiliary diagnosis of the second stage of AESD, and in AESD, PCT is likely to increase through a different mechanism.